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Cleland H, Stewardson A, Padiglione A, Tracy L. Bloodstream infections and multidrug resistant bacteria acquisition among burns patients in Australia and New Zealand: A registry-based study. Burns 2024; 50:1544-1554. [PMID: 38714428 DOI: 10.1016/j.burns.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 01/29/2024] [Accepted: 03/11/2024] [Indexed: 05/09/2024]
Abstract
INTRODUCTION This study interrogates infection related data in the Burns Registry of Australia and New Zealand (BRANZ), to examine associations of multi-drug resistant organisms (MDROs) and blood stream infection (BSI). METHODS Data between July 2016 and June 2021 were analysed to determine prevalence, risk factors and outcomes associated with BSIs and MDROs: Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), carbapenem-resistant Pseudomonas spp. (CRP), and carbapenem-resistant Enterobacter (CRE). Data completeness and value for quality improvement activity were assessed. RESULTS We found a low incidence (3.4%) of the resistant organisms of interest, and no change over the study period. Fequency varied between services and increased with age and size of burn. MRSA was the commonest organism in all age groups. A positive BSI result occurred in 1.6% of patients (12.1% of cultures taken) at a median time of 10.2 days post injury. Free text identification of organisms was inconsistently documented. CONCLUSIONS The low rate and patterns of acquisition of MDROs of interest and BSIs is comparable with reports from countries with low incidence of massive burns. Wider adoption of a standardized laboratory reporting framework would help realise the potential of clinical quality registries to provide data which supports evidence based infection prevention initiatives.
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Affiliation(s)
- Heather Cleland
- Victorian Adult Burns Service, Alfred Hospital, Melbourne, Australia; Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia.
| | - Andrew Stewardson
- Department of Infectious Diseases, Alfred Hospital, Melbourne, Australia; Department of Infectious diseases,Central Clinical School, Monash University, Melbourne, Australia
| | - Alex Padiglione
- Department of Infectious Diseases, Alfred Hospital, Melbourne, Australia
| | - Lincoln Tracy
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Gurbuz K, Das K, Demir M, Suntur BM, Ozlu O, Basaran A, Cil MK, Golbol A. Impacts of intelligent monitoring technology installation and additional modalities on hand hygiene compliance in a burn center: A quasi-experimental longitudinal trial. Burns 2024; 50:1307-1314. [PMID: 38458960 DOI: 10.1016/j.burns.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/23/2024] [Accepted: 02/26/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND The increasing development of intelligent technologies for hand hygiene (HH) compliance audit has the potential to create an alternative to direct observation (DO), which is still considered the gold standard but has disadvantages such as lack of standardized monitoring practices, Hawthorne effect, insufficient sample size, and time/resource consumption. We aimed to share our preliminary results on the impacts of intelligent monitoring technology installation (IMTI) and additional modalities on healthcare workers' (HCWs') HH compliance in a Burn Center, according to the "5 Moments of HH" concept defined by the World Health Organization (WHO). METHODS A quasi-experimental longitudinal trial was conducted over eleven months.The first phase of the three-stage study evaluated basic HH compliances obtained by DO. The system-defined HH performances, which IMTI recorded, were assessed in the second phase. Finally, the effect of IMTI and additional modalities was determined in the third stage. RESULTS 15202 HH events were performed by 41 HCWs, and a total of 20095 HH opportunities were observed. Four hundred fifty-five opportunities were in the preinstallation phase, and 19640 were during the total post-installation period. IMTIdefined performance rates in both Phase 2 (71.2%) and Phase 3 (80.5%) were generally considerably higher than HH compliances obtained from DO (58.5%). Nurses, physical therapy /anesthesia technicians, and housekeeping personnel showed significant increases, which was insignificant in physicians in phase 2. Meanwhile, a sustained increase was observed regarding IMTI and additional modalities of HH compliance of all HCWs in Phase 3. CONCLUSION IMTI has significantly increased HH performance rates. Furthermore, combining the IMTI with additional modalities as components of a multimodal strategy recommended by WHO appears to affect the sustainability of the increasing trend of HCWs' HH compliance.
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Affiliation(s)
- Kayhan Gurbuz
- University of Health Sciences, Adana City Training and Research Hospital, Department of General Surgery, Burn Center, Adana, Turkiye.
| | - Koray Das
- University of Health Sciences, Adana City Training and Research Hospital, Department of General Surgery, Burn Center, Adana, Turkiye
| | - Mete Demir
- University of Health Sciences, Adana City Training and Research Hospital, Department of General Surgery, Burn Center, Adana, Turkiye
| | - Bedia Mutay Suntur
- University of Health Sciences, Adana City Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Adana, Turkiye
| | - Ozer Ozlu
- University of Health Sciences, Adana City Training and Research Hospital, Department of General Surgery, Burn Center, Adana, Turkiye
| | - Abdulkadir Basaran
- University of Health Sciences, Adana City Training and Research Hospital, Department of General Surgery, Burn Center, Adana, Turkiye
| | - Merve Kilic Cil
- University of Health Sciences, Adana City Training and Research Hospital, Department of Pediatric Infectious Diseases, Adana, Turkiye
| | - Abdullah Golbol
- University of Health Sciences, Adana City Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Adana, Turkiye
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Choong E, Jurat D, Sandeep B, Rainnie B, Manzanero S, Dowsey M, McPhail S, Choong PF, Wood F. The impact of infection on length of stay in adult burns: A scoping review. Burns 2024; 50:797-807. [PMID: 38307765 DOI: 10.1016/j.burns.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/29/2023] [Accepted: 01/10/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND The disruption to the immune system and profound metabolic response to burn injury gives rise to a unique susceptibility to infection. Indeed, infection is one of the most frequently encountered post-burns complications placing significant burden on patients and healthcare system. Advancements in burn care have led to marked improvements in burn-related mortality and morbidity; however, scarce hospital resources hamper adequate burn-related care, and patient length of stay (LOS) in hospital is an important drain on such resources. The aim of this review was to assess and evaluate the existing literature relating to the impact of infections on LOS in hospitalised, adult burn patients. METHODS Electronic searches were performed in Medline and Embase. Eligible studies were those reporting on LOS and infection in adult burn populations. Articles published before 2000 were excluded to ensure that the analysis was focused on contemporary literature that reflects current, clinical management of burn patients. RESULTS Nineteen studies (54,397 burn patients) were included in the review. All studies were retrospective, with the majority undertaken in North America (14 studies). The mean age range was 38-67 years and the majority of patients were male. Inhalation injury was recorded in eleven studies. The most common types of infection included pneumonia, blood stream infections (BSI) and burn wound infections. Overall, there was a trend towards a positive association between infection and LOS. CONCLUSION The results of this scoping review provide an overview of the existing literature on the relationship between infection and LOS in adult burn populations. However, significant gaps remain in knowledge which call for further high-quality research. Standardised definitions for the collection of infection data and the use of burns specific infection control guidelines are also critical to understanding and improving patient outcomes.
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Affiliation(s)
- Emma Choong
- Infection Collaboration in trAuma, orthopaedics and burns (ICARAUS), Australia; St Vincent's Hospital Melbourne, Fitzroy 3065, Victoria, Australia; University of Melbourne, Department of Surgery, St. Vincent's Hospital Melbourne, Victoria, Australia.
| | - Danika Jurat
- Infection Collaboration in trAuma, orthopaedics and burns (ICARAUS), Australia; State Burns Unit, Fiona Stanley Hospital, Murdoch 6150, Western Australia, Australia
| | - B Sandeep
- Infection Collaboration in trAuma, orthopaedics and burns (ICARAUS), Australia; State Burns Unit, Fiona Stanley Hospital, Murdoch 6150, Western Australia, Australia
| | - Briana Rainnie
- Infection Collaboration in trAuma, orthopaedics and burns (ICARAUS), Australia; Royal Brisbane and Women's Hospital, Herston 4029, Queensland, Australia
| | - Silvia Manzanero
- Infection Collaboration in trAuma, orthopaedics and burns (ICARAUS), Australia; Jamieson Trauma Institute, Metro North Health, Butterfield Street, Herston, Brisbane, QLD 4029, Australia; School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Michelle Dowsey
- Infection Collaboration in trAuma, orthopaedics and burns (ICARAUS), Australia; University of Melbourne, Department of Surgery, St. Vincent's Hospital Melbourne, Victoria, Australia
| | - Steven McPhail
- Infection Collaboration in trAuma, orthopaedics and burns (ICARAUS), Australia; Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove 4059, Queensland, Australia; Digital Health and Informatics Directorate, Metro South Health, Woolloongabba 4102, Queensland, Australia
| | - Peter Fm Choong
- Infection Collaboration in trAuma, orthopaedics and burns (ICARAUS), Australia; University of Melbourne, Department of Surgery, St. Vincent's Hospital Melbourne, Victoria, Australia
| | - Fiona Wood
- Infection Collaboration in trAuma, orthopaedics and burns (ICARAUS), Australia; State Burns Unit, Fiona Stanley Hospital, Murdoch 6150, Western Australia, Australia
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Yin B, He Y, Zhang Z, Cheng X, Bao W, Li S, Wang W, Jia C. Global burden of burns and its association with socio-economic development status, 1990-2019. Burns 2024; 50:321-374. [PMID: 38102041 DOI: 10.1016/j.burns.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 02/06/2023] [Accepted: 02/19/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Burns represent important global health problems. Whereas many studies are limited by the difficulties in estimating the burden of burns and instead focus on the causes of burns, such as fire, heat, and hot substances. Therefore, a complete assessment of the burden of all injuries leading to burns is essential to developing reasonable global intervention strategies. METHODS Data on three classes of burns, including "< 20 % total burned surface area without lower airway burns" (Moderate injury), "> =20 % total burned surface area or > = 10 % burned surface area if head/neck or hands/wrist involved w/o lower airway burns" (Major injury), "Lower airway burns" (Inhalation injury) were collected from the Global Burden of Disease 2019 database. Age-standardized incidence rates (ASR-I) and Years Lived with Disability (ASR-YLDs) for burns has been standardized by removing the influence of population size and age structure. They were extracted and stratified by cause, year, sex, age, socio-demographic index, country, and territory. RESULTS In terms of ASR-I and ASR-YLDs, burns showed a significant decrease from 1990 to 2019, especially for moderate and major injury. In 2019, the burden of moderate injury was positively correlated with socio-demographic index while major injury was negatively correlated (P < 0.05). We found no correlation between socio-demographic index and the burden for inhalation injury (P > 0.05). Fire, heat, and hot substances were the most important cause of burns except for inhalation injury. The most common association with inhalation injury was falls, which were also a major cause of moderate and major injury. CONCLUSIONS The Global Burden of Disease 2019 database data can be used to guide the allocation of resources to reduce ASR-I and ASR-YLDs of different burn classes.
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Affiliation(s)
- Bin Yin
- School of Medicine, Xiamen University, Xiamen, China
| | - Yan He
- School of Medicine, Xiamen University, Xiamen, China
| | - Zexin Zhang
- School of Medicine, Xiamen University, Xiamen, China
| | - Xialin Cheng
- School of Medicine, Xiamen University, Xiamen, China
| | - Wu Bao
- School of Medicine, Xiamen University, Xiamen, China
| | - Shu Li
- School of Medicine, Xiamen University, Xiamen, China
| | - Wenxuan Wang
- School of Medicine, Xiamen University, Xiamen, China
| | - Chiyu Jia
- The First Affiliated Hospital, Center of Burn & Plastic and Wound Healing Surgery, Hengyang Medical School, University of South China, Hengyang, Hunan 421001, China.
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King N, Dhumal D, Lew SQ, Kuo SH, Galanakou C, Oh MW, Chong SY, Zhang N, Lee LTO, Hayouka Z, Peng L, Lau GW. Amphiphilic Dendrimer as Potent Antibacterial against Drug-Resistant Bacteria in Mouse Models of Human Infectious Diseases. ACS Infect Dis 2024; 10:453-466. [PMID: 38241613 DOI: 10.1021/acsinfecdis.3c00425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
Modern medicine continues to struggle against antibiotic-resistant bacterial pathogens. Among the pathogens of critical concerns are the multidrug-resistant (MDR) Pseudomonas aeruginosa, Staphylococcus aureus, and Klebsiella pneumoniae. These pathogens are major causes of nosocomial infections among immunocompromised individuals, involving major organs such as lung, skin, spleen, kidney, liver, and bloodstream. Therefore, novel approaches are direly needed. Recently, we developed an amphiphilic dendrimer DDC18-8A exhibiting high antibacterial and antibiofilm efficacy in vitro. DDC18-8A is composed of a long hydrophobic alkyl chain and a small hydrophilic poly(amidoamine) dendron bearing amine terminals, exerting its antibacterial activity by attaching and inserting itself into bacterial membranes to trigger cell lysis. Here, we examined the pharmacokinetics and in vivo toxicity as well as the antibacterial efficacy of DDC18-8A in mouse models of human infectious diseases. Remarkably, DDC18-8A significantly reduced the bacterial burden in mouse models of acute pneumonia and bacteremia by P. aeruginosa, methicillin-resistant S. aureus (MRSA), and carbapenem-resistant K. pneumoniae and neutropenic soft tissue infection by P. aeruginosa and MRSA. Most importantly, DDC18-8A outperformed pathogen-specific antibiotics against all three pathogens by achieving a similar bacterial clearance at 10-fold lower therapeutic concentrations. In addition, it showed superior stability and biodistribution in vivo, with excellent safety profiles yet without any observable abnormalities in histopathological analysis of major organs, blood serum biochemistry, and hematology. Collectively, we provide strong evidence that DDC18-8A is a promising alternative to the currently prescribed antibiotics in addressing challenges associated with nosocomial infections by MDR pathogens.
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Affiliation(s)
- Noah King
- Department of Pathobiology, University of Illinois at Urbana-Champaign, Urbana, Illinois 61802, United States
| | - Dinesh Dhumal
- CNRS, Centre Interdisciplinaire de Nanoscience de Marseille (CINaM), UMR 7325, Equipe Labelisée Ligue Contre le Cancer, Aix Marseille University, Parc Scientifique et Technologique de Luminy 913, Marseille 13288, France
| | - Shi Qian Lew
- Department of Pathobiology, University of Illinois at Urbana-Champaign, Urbana, Illinois 61802, United States
| | - Shanny Hsuan Kuo
- Department of Pathobiology, University of Illinois at Urbana-Champaign, Urbana, Illinois 61802, United States
| | - Christina Galanakou
- CNRS, Centre Interdisciplinaire de Nanoscience de Marseille (CINaM), UMR 7325, Equipe Labelisée Ligue Contre le Cancer, Aix Marseille University, Parc Scientifique et Technologique de Luminy 913, Marseille 13288, France
| | - Myung Whan Oh
- Department of Pathobiology, University of Illinois at Urbana-Champaign, Urbana, Illinois 61802, United States
| | - Sook Yin Chong
- Department of Pathobiology, University of Illinois at Urbana-Champaign, Urbana, Illinois 61802, United States
| | - Nian Zhang
- Faculty of Health Sciences, University of Macau, Taipa 999078, Macau, China
| | - Leo Tsz On Lee
- Faculty of Health Sciences, University of Macau, Taipa 999078, Macau, China
- Ministry of Education Frontiers Science Center for Precision Oncology, University of Macau, Taipa 999078, Macau, China
| | - Zvi Hayouka
- Institute of Biochemistry, Food Science and Nutrition, the Robert H. Smith Faculty of Agriculture, Food and Environment, the Hebrew University of Jerusalem, Rehovot 76100, Israel
| | - Ling Peng
- CNRS, Centre Interdisciplinaire de Nanoscience de Marseille (CINaM), UMR 7325, Equipe Labelisée Ligue Contre le Cancer, Aix Marseille University, Parc Scientifique et Technologique de Luminy 913, Marseille 13288, France
| | - Gee W Lau
- Department of Pathobiology, University of Illinois at Urbana-Champaign, Urbana, Illinois 61802, United States
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Askarian F, Tsai CM, Cordara G, Zurich RH, Bjånes E, Golten O, Vinther Sørensen H, Kousha A, Meier A, Chikwati E, Bruun JA, Ludviksen JA, Choudhury B, Trieu D, Davis S, Edvardsen PKT, Mollnes TE, Liu GY, Krengel U, Conrad DJ, Vaaje-Kolstad G, Nizet V. Immunization with lytic polysaccharide monooxygenase CbpD induces protective immunity against Pseudomonas aeruginosa pneumonia. Proc Natl Acad Sci U S A 2023; 120:e2301538120. [PMID: 37459522 PMCID: PMC10372616 DOI: 10.1073/pnas.2301538120] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/30/2023] [Indexed: 07/20/2023] Open
Abstract
Pseudomonas aeruginosa (PA) CbpD belongs to the lytic polysaccharide monooxygenases (LPMOs), a family of enzymes that cleave chitin or related polysaccharides. Here, we demonstrate a virulence role of CbpD in PA pneumonia linked to impairment of host complement function and opsonophagocytic clearance. Following intratracheal challenge, a PA ΔCbpD mutant was more easily cleared and produced less mortality than the wild-type parent strain. The x-ray crystal structure of the CbpD LPMO domain was solved to subatomic resolution (0.75Å) and its two additional domains modeled by small-angle X-ray scattering and Alphafold2 machine-learning algorithms, allowing structure-based immune epitope mapping. Immunization of naive mice with recombinant CbpD generated high IgG antibody titers that promoted human neutrophil opsonophagocytic killing, neutralized enzymatic activity, and protected against lethal PA pneumonia and sepsis. IgG antibodies generated against full-length CbpD or its noncatalytic M2+CBM73 domains were opsonic and protective, even in previously PA-exposed mice, while antibodies targeting the AA10 domain were not. Preexisting antibodies in PA-colonized cystic fibrosis patients primarily target the CbpD AA10 catalytic domain. Further exploration of LPMO family proteins, present across many clinically important and antibiotic-resistant human pathogens, may yield novel and effective vaccine antigens.
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Affiliation(s)
- Fatemeh Askarian
- Division of Host-Microbe Systems & Therapeutics, Department of Pediatrics, University of California San Diego, La Jolla, CA92093
| | - Chih-Ming Tsai
- Division of Host-Microbe Systems & Therapeutics, Department of Pediatrics, University of California San Diego, La Jolla, CA92093
| | | | - Raymond H. Zurich
- Division of Host-Microbe Systems & Therapeutics, Department of Pediatrics, University of California San Diego, La Jolla, CA92093
| | - Elisabet Bjånes
- Division of Host-Microbe Systems & Therapeutics, Department of Pediatrics, University of California San Diego, La Jolla, CA92093
| | - Ole Golten
- Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, N-1432Ås, Norway
| | | | - Armin Kousha
- Division of Host-Microbe Systems & Therapeutics, Department of Pediatrics, University of California San Diego, La Jolla, CA92093
| | - Angela Meier
- Division of Critical Care, Department of Anesthesiology, University of California San Diego, La Jolla, CA92037
| | - Elvis Chikwati
- Department of Paraclinical Sciences, Faculty of Veterinary Medicine, Norwegian University of Life Sciences, N-1432Ås, Norway
| | - Jack-Ansgar Bruun
- Proteomics and Metabolomics Core Facility, Department of Medical Biology, The Arctic University of Norway, N-9037Tromsø, Norway
| | | | - Biswa Choudhury
- Glycobiology Research and Training Center, University of California San Diego, La Jolla, CA92093
| | - Desmond Trieu
- Division of Host-Microbe Systems & Therapeutics, Department of Pediatrics, University of California San Diego, La Jolla, CA92093
- School of Pharmacy, University of California San Francisco, San Francisco, CA94143
| | - Stanley Davis
- Division of Host-Microbe Systems & Therapeutics, Department of Pediatrics, University of California San Diego, La Jolla, CA92093
| | | | - Tom Eirik Mollnes
- Research Laboratory, Nordland Hospital, N-8005Bodø, Norway
- Department of Immunology, University of Oslo Hospital, N-0424Oslo, Norway
- Center of Molecular Inflammation Research, Norwegian University of Science and Technology, N-7491Trondheim, Norway
| | - George Y. Liu
- Division of Host-Microbe Systems & Therapeutics, Department of Pediatrics, University of California San Diego, La Jolla, CA92093
| | - Ute Krengel
- Department of Chemistry, University of Oslo, N-0315Oslo, Norway
| | - Douglas J. Conrad
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, La Jolla, CA92037
| | - Gustav Vaaje-Kolstad
- Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, N-1432Ås, Norway
| | - Victor Nizet
- Division of Host-Microbe Systems & Therapeutics, Department of Pediatrics, University of California San Diego, La Jolla, CA92093
- Glycobiology Research and Training Center, University of California San Diego, La Jolla, CA92093
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla, CA92093
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Nitsani Y, Michael T, Halpern D, Hasidim AA, Sher M, Givoli Vilensky R, Krieger Y, Silberstein E, Shoham Y. Blood Stream Infections in Burns: A 14-Year Cohort Analysis. Life (Basel) 2023; 13:1357. [PMID: 37374139 DOI: 10.3390/life13061357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/30/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Blood stream infections are a significant cause of morbidity and mortality in burns, and pathogen identification is important for treatment. This study aims to characterize the microbiology of these infections and the association between the infecting pathogen and the hospitalization course. METHODS We conducted a cohort study that included records of burn patients treated at the Soroka University Medical Center between 2007-2020. Statistical analysis of demographic and clinical data was performed to explore relationships between burn characteristics and outcomes. Patients with positive blood cultures were divided into four groups: Gram-positive, Gram-negative, mixed-bacterial, and fungal. RESULTS Of the 2029 burn patients hospitalized, 11.7% had positive blood cultures. The most common pathogens were Candida and Pseudomonas. We found significant differences in ICU admission, need for surgery, and mortality between the infected and non-infected groups (p < 0.001). Pathogen groups differed significantly mean TBSA, ICU admission, need for surgery, and mortality (p < 0.001). Multivariate analysis showed flame (OR 2.84) and electric burns (OR 4.58) were independent risk factors for ICU admission and surgical intervention (p < 0.001). Gram-negative bacterial infection was found to be an independent predictor of mortality (OR = 9.29, p < 0.001). CONCLUSIONS Anticipating specific pathogens which are associated with certain burn characteristics may help guide future therapy.
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Affiliation(s)
- Yarden Nitsani
- Joyce & Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba 8410501, Israel
| | - Tal Michael
- Department of Epidemiology, Biostatistics, and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba 8410501, Israel
| | - Dor Halpern
- Joyce & Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba 8410501, Israel
| | - Ariel Avraham Hasidim
- Joyce & Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba 8410501, Israel
| | - Maayan Sher
- Joyce & Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba 8410501, Israel
| | - Rotem Givoli Vilensky
- Clinical Research Center, Soroka University Medical Center, Beer-Sheba 8410101, Israel
| | - Yuval Krieger
- Plastic and Reconstructive Surgery Department and Burn Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba 8410501, Israel
| | - Eldad Silberstein
- Plastic and Reconstructive Surgery Department and Burn Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba 8410501, Israel
| | - Yaron Shoham
- Plastic and Reconstructive Surgery Department and Burn Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba 8410501, Israel
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8
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Egro F, Repko A, Narayanaswamy V, Ejaz A, Kim D, Schusterman MA, Loughran A, Ayyash A, Towsend SM, Baker S, Ziembicki J, Marra K, Rubin P. Soluble chitosan derivative treats wound infections and promotes wound healing in a novel MRSA-infected porcine partial-thickness burn wound model. PLoS One 2022; 17:e0274455. [PMID: 36240206 PMCID: PMC9565743 DOI: 10.1371/journal.pone.0274455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 08/28/2022] [Indexed: 11/19/2022] Open
Abstract
Burns are physically debilitating and potentially fatal injuries. The most common etiology of burn wound infections in the US is methicillin-resistant Staphylococcus aureus (MRSA), which is particularly recalcitrant when biofilms form. The current standard of care, silver sulfadiazine (SSD) is effective in reducing bacterial load, but less effective in improving burn wound healing. New treatments that can manage infection while simultaneously improving healing would provide a benefit in the treatment of burns. Porcine models are frequently used as a model for human wound healing but can be expensive due to the need to separate wounds to avoid cross contamination. The porcine model developed in this study offers the capability to study multiple partial thickness burn wound (PTBW) sites on a single animal with minimal crosstalk to study wound healing, infection, and inflammation. The current study evaluates a wound rinse and a wound gel formulated with a non-toxic, polycationic chitosan derivative that is hypothesized to manage infection while also promoting healing, providing a potential alternate to SSD. Studies in vitro and in this PTBW porcine model compare treatment with the chitosan derivative formulations to SSD. The wound rinse and wound gel are observed to disrupt mature MRSA biofilms in vitro and reduce the MRSA load in vivo when compared to that of the standard of care. In vivo data further show increased re-epithelialization and faster healing in burns treated with wound rinse/gel as compared to SSD. Taken together, the data demonstrate the potential of the wound rinse/gel to significantly enhance healing, promote re-epithelialization, and reduce bacterial burden in infected PTBW using an economical porcine model.
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Affiliation(s)
- Francesco Egro
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Alex Repko
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America
| | | | - Asim Ejaz
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Deokyeol Kim
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - M. Asher Schusterman
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America
| | | | - Ali Ayyash
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America
| | | | - Shenda Baker
- Synedgen Inc., Claremont, CA, United States of America
| | - Jenny Ziembicki
- Department of Surgery, University of Pittsburgh Medical Center Mercy, Pittsburgh, PA, United States of America
| | - Kacey Marra
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States of America
- McGowan Institute of Regenerative Medicine, Pittsburgh, PA, United States of America
| | - Peter Rubin
- Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States of America
- McGowan Institute of Regenerative Medicine, Pittsburgh, PA, United States of America
- * E-mail:
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9
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Tan XYD, Wiseman T, Betihavas V. Risk factors for nosocomial infections and/or sepsis in adult burns patients: An integrative review. Intensive Crit Care Nurs 2022; 73:103292. [PMID: 35879132 DOI: 10.1016/j.iccn.2022.103292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 06/06/2022] [Accepted: 06/12/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND In comparison to general trauma patients, loss of skin barrier amongst the burns cohort predisposes them to a higher risk of nosocomial infections and sepsis, and this often leads to unfavourable morbidity and mortality outcomes. PURPOSE This integrative review aimed to explore existing literature to identify risk factors related to nosocomial infections and/or sepsis in adult burns patients following hospital admission. METHODS Electronic searches for journals published between 2007 and 2021 were performed in CINAHL, Scopus and Medline, and key journals were hand-searched. Inclusion criteria was: (1) peer-reviewed, primary studies; (2) qualitative, quantitative or mixed-methods studies; (3) study participants had sustained burns-related injury and developed nosocomial infections and/or sepsis during the course of hospitalisation. Studies were appraised using the Critical Appraisal Skill Program checklists. RESULTS 15 studies ranging from 'poor' to 'fair' to 'moderate' quality were included in the final review. Patient factors that contributed to the development of nosocomial infections and/ or sepsis included: (1) Full thickness burns; (2) age; (3) % Total Burns Surface Area; and (4) Herpes Simplex Virus activation. Several provider-system risk factors were identified by 'poor' quality studies and further research is required to substantiate those findings. DISCUSSION Findings remained inconclusive due to the lack of 'good' quality studies however, there was an overemphasis on patient-related risk factors instead of healthcare workers or the system. Future research may focus on activation of the latest infection prevention strategies and early enforcement of care bundles. Through identification of related risk factors, it may reduce the incidence of nosocomial infection and/or sepsis post-burns.
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Affiliation(s)
- Xue Ying Debbie Tan
- Susan Wakil School of Nursing & Midwifery, Susan Wakil School of Nursing & Midwifery, Australia.
| | - Taneal Wiseman
- Susan Wakil School of Nursing & Midwifery, Susan Wakil School of Nursing & Midwifery, Australia
| | - Vasiliki Betihavas
- Susan Wakil School of Nursing & Midwifery, Susan Wakil School of Nursing & Midwifery, Australia
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10
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Tapking C, Hundeshagen G, Kirchner M, Fischer S, Kneser U, Bliesener B. Tranexamic acid reduced blood transfusions in acute burn surgery: A retrospective case-controlled trial. Burns 2022; 48:522-528. [PMID: 35339324 DOI: 10.1016/j.burns.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/15/2022] [Accepted: 03/12/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Early excision and grafting of burn wounds are key for reducing prevalence of infection and sepsis. However, it is associated with massive blood loss and patients frequently require large numbers of blood transfusions. This study aimed to evaluate the effect of tranexamic acid (TXA) on blood transfusion requirements in acute burn surgery. METHODS Patients admitted to the burn intensive care unit between January 2018 and May 2021 and received TXA before first surgery for wound excision and grafting were matched in a 1:2 ratio to patients that did not receive TXA (confounders age,sex,total body surface area (TBSA) burned). Primary endpoint of the analysis was the total number of transfused units of red blood cells (RBC) intra- and postoperatively up to 48 h. Fresh frozen plasma (FFP) and platelets were evaluated. Endpoints were compared between groups using van Elteren tests adjusting for strata variable age, gender, TBSA. RESULTS Twenty-six TXA patients were matched with 52 control patients resulting in similar distributions of gender (77.9%(TXA)vs. 82.7%(control) males, p=0.542), age (51.7±21.3vs.48.3 ±17.4years,p = 0.459) and %TBSA burned (33.5%(IQR34)vs. 38.5% (IQR 30.5),p = 1.000). TXA group received significantly less RBC units intraoperatively (2.5(IQR 2.0)vs.4.0 units (IQR4.0), p = 0.038) and in total (4.0(IQR3.0)vs.6.0(IQR4.0),p = 0.017). TXA patients also received less blood products in general (RBC, FFP, platelets) in each period and in total. We found no significant difference in length of stay (24.0(IQR26.0)vs.33.0 days (IQR 0.5),p = 0.367) or mortality (15.4%vs.21.2%, p = 0.542). DISCUSSION This study shows that necessity for blood transfusions in acute burn surgery may be reduced significantly by administration of TXA perioperatively. Randomized-controlled trials are needed to prove these findings.
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Affiliation(s)
- C Tapking
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - G Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - M Kirchner
- Institute of Medical Biometry, University Hospital Heidelberg, Heidelberg, Germany
| | - S Fischer
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - U Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
| | - B Bliesener
- Department of Hand, Plastic and Reconstructive Surgery, Microsurgery, Burn Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany; Department of Anesthesia, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany.
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11
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Kaita Y, Otsu A, Tanaka Y, Yoshikawa K, Matsuda T, Yamaguchi Y. Epidemiology of bloodstream infections and surface swab cultures in burn patients. Acute Med Surg 2022; 9:e752. [PMID: 35572048 PMCID: PMC9080972 DOI: 10.1002/ams2.752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/20/2022] [Indexed: 11/11/2022] Open
Abstract
Aim For infection control in burn patients, it is essential to understand the epidemiology of bloodstream infection (BSI) and the local microbiological situation. There are few studies on blood and swab culture results among burn patients in Japan. The purpose of this study was to investigate the epidemiology of BSI and swab cultures in burn patients. Methods Data from 355 burn patients over 13 years from 2008 were analyzed retrospectively. Bloodstream infection was defined as the isolation of bacteria or fungi from two or more blood cultures. The characteristics of burn patients and microorganisms detected from various cultures were analyzed. Results The mortality rate among burn patients with BSI was 37.8%, which was more than twice that among burn patients without BSI. The univariate analysis showed that inhalation injury, total burn surface area (TBSA), and mortality were associated with BSI. The multivariate logistic analysis indicated that TBSA was an independent risk factor for BSI. The most frequently isolated organism from blood and swab cultures were Candida species and Pseudomonas aeruginosa, respectively. Seventy‐five percent of the microorganisms isolated from blood were detected previously in swab cultures performed within 1 week from blood cultures. Conclusions The prognosis of burn patients with BSI was poor, and TBSA was an independent risk factor for BSI. The predominant organisms isolated from blood and swab cultures were Candida species and P. aeruginosa, respectively. Surveillance wound swab cultures could be utilized for monitoring the local microbiological situation in burn patients.
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Affiliation(s)
- Yasuhiko Kaita
- Department of Trauma and Critical Care Medicine Kyorin University School of Medicine Tokyo Japan
| | - Akiyasu Otsu
- Department of Trauma and Critical Care Medicine Kyorin University School of Medicine Tokyo Japan
| | - Yuya Tanaka
- Department of Trauma and Critical Care Medicine Kyorin University School of Medicine Tokyo Japan
| | - Kei Yoshikawa
- Department of Trauma and Critical Care Medicine Kyorin University School of Medicine Tokyo Japan
| | - Takeaki Matsuda
- Department of Trauma and Critical Care Medicine Kyorin University School of Medicine Tokyo Japan
| | - Yoshihiro Yamaguchi
- Department of Trauma and Critical Care Medicine Kyorin University School of Medicine Tokyo Japan
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12
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Hu Y, Li D, Xu L, Hu Y, Sang Y, Zhang G, Dai H. Epidemiology and outcomes of bloodstream infections in severe burn patients: a six-year retrospective study. Antimicrob Resist Infect Control 2021; 10:98. [PMID: 34193300 PMCID: PMC8243830 DOI: 10.1186/s13756-021-00969-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/15/2021] [Indexed: 11/30/2022] Open
Abstract
Background Infection is the leading cause of morbidity and mortality among burn patients, and bloodstream infection (BSI) is the most serious. This study aimed to evaluate the epidemiology and clinical outcomes of BSI in severe burn patients. Methods Clinical variables of all patients admitted with severe burns (≥ 20% total body surface area, %TBSA) were analyzed retrospectively from January 2013 to December 2018 at a teaching hospital. The Kaplan–Meier method was utilized for plotting survival curves. Multivariate logistic regression and Cox regression model were also performed. Results A total of 495 patients were evaluated, of whom 136 (27.5%) had a BSI. The median time from the patients being burned to BSI was 8 days. For BSI onset in these patients, 47.8% (65/136) occurred in the first week. The most frequently isolated causative organism was A. baumannii (22.7%), followed by methicillin-resistant Staphylococcus aureus (18.7%) and K. pneumoniae (18.2%), in patients with BSI. Multivariate logistic regression analysis showed that %TBSA (p = 0.023), mechanical ventilation (p = 0.019), central venous catheter (CVC) (p < 0.001) and hospital length of stay (27d vs 50d, p < 0.001) were independent risk factors associated with BSI. Cox regression model showed that acute kidney injury (HR, 12.26; 95% CI 2.31–64.98; p = 0.003) and septic shock (HR, 4.36; 95% CI 1.16–16.34; p = 0.031) were identified as independent predictors of 30-day mortality of BSI in burn patients. Conclusions Multidrug resistant gram-negative bacteria were the main pathogens of BSI in severe burn patients. Accurate evaluation of risk factors for BSI and the mortality of BSI in severe burn patients may improve early appropriate management.
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Affiliation(s)
- Yangmin Hu
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Danyang Li
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Lingcheng Xu
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Yuping Hu
- Department of Pharmacy, Hangzhou Third People's Hospital, Hangzhou, 310009, China
| | - Yiwen Sang
- Department of Laboratory Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Gensheng Zhang
- Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Haibin Dai
- Department of Pharmacy, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China.
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13
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Bennett RC, Oh MW, Kuo SH, Belo Y, Maron B, Malach E, Lin J, Hayouka Z, Lau GW. Random Peptide Mixtures as Safe and Effective Antimicrobials against Pseudomonas aeruginosa and MRSA in Mouse Models of Bacteremia and Pneumonia. ACS Infect Dis 2021; 7:672-680. [PMID: 33650856 DOI: 10.1021/acsinfecdis.0c00871] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Antibiotic resistance is a daunting challenge in modern medicine, and novel approaches that minimize the emergence of resistant pathogens are desperately needed. Antimicrobial peptides are newer therapeutics that attempt to do this; however, they fall short because of low to moderate antimicrobial activity, low protease stability, susceptibility to resistance development, and high cost of production. The recently developed random peptide mixtures (RPMs) are promising alternatives. RPMs are synthesized by incorporating a defined proportion of two amino acids at each coupling step rather than just one, making them highly variable but still defined in their overall composition, chain length, and stereochemistry. Because RPMs have extreme diversity, it is unlikely that bacteria would be capable of rapidly evolving resistance. However, their efficacy against pathogens in animal models of human infectious diseases remained uncharacterized. Here, we demonstrated that RPMs have strong safety and pharmacokinetic profiles. RPMs rapidly killed both Pseudomonas aeruginosa and Staphylococcus aureus efficiently and disrupted preformed biofilms by both pathogens. Importantly, RPMs were efficacious against both pathogens in mouse models of bacteremia and acute pneumonia. Our results demonstrate that RPMs are potent broad-spectrum therapeutics against antibiotic-resistant pathogens.
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Affiliation(s)
- Richard C. Bennett
- Department of Pathobiology, University of Illinois at Urbana−Champaign, Urbana, Illinois 61802, United States
| | - Myung Whan Oh
- Department of Pathobiology, University of Illinois at Urbana−Champaign, Urbana, Illinois 61802, United States
| | - Shanny Hsuan Kuo
- Department of Pathobiology, University of Illinois at Urbana−Champaign, Urbana, Illinois 61802, United States
| | - Yael Belo
- Institute of Biochemistry, Food Science and Nutrition, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot 76100, Israel
| | - Bar Maron
- Institute of Biochemistry, Food Science and Nutrition, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot 76100, Israel
| | - Einav Malach
- Institute of Biochemistry, Food Science and Nutrition, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot 76100, Israel
| | - Jingjun Lin
- Department of Pathobiology, University of Illinois at Urbana−Champaign, Urbana, Illinois 61802, United States
| | - Zvi Hayouka
- Institute of Biochemistry, Food Science and Nutrition, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot 76100, Israel
| | - Gee W. Lau
- Department of Pathobiology, University of Illinois at Urbana−Champaign, Urbana, Illinois 61802, United States
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14
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Gong J, Singer Y, Cleland H, Wood F, Cameron P, Tracy LM, Gabbe BJ. Driving improved burns care and patient outcomes through clinical registry data: A review of quality indicators in the Burns Registry of Australia and New Zealand. Burns 2021; 47:14-24. [PMID: 32811694 DOI: 10.1016/j.burns.2020.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/19/2019] [Accepted: 01/16/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND In 2009, the Burns Registry of Australia and New Zealand (BRANZ) published a set of clinical quality indicators (QIs) to monitor performance, improve quality of care, and inform and change policy. With several years of data collected since the initial development of the indicators for burns, the BRANZ QI Working Party reviewed the clinical QIs for relevance and meaning, and considered new QIs that had not been collected previously. METHOD Using published literature and expert opinion, the QI Working Party, consisting of multidisciplinary burn clinicians, reviewed the QIs for burn care to be included as routine data items in the BRANZ. RESULTS In July 2016, the list of clinical QIs in the BRANZ was updated to 23 QIs/data items, covering structure, process, and outcome measures. Four QIs were removed as they were not found to be useful, nine QIs/data items were revised, and eight new QIs/data items were added as they were considered to be clinically useful. CONCLUSION This review outlines the changes made to the QIs collected by the BRANZ four years since their development and implementation. Ongoing refinement of the BRANZ QIs will ensure that high quality data is collected to drive improvements in clinical and patient outcomes.
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Affiliation(s)
- Jennifer Gong
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Yvonne Singer
- Victorian Adult Burns Service, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Heather Cleland
- Victorian Adult Burns Service, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Fiona Wood
- State Adult Burn Unit, Fiona Stanley Hospital, 11 Warren Drive, Murdoch, Western Australia, 6150, Australia; Burn Injury Research Unit, University of Western Australia, Perth, Western Australia, 6009, Australia
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia; Emergency and Trauma Centre, Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, 3004, Australia
| | - Lincoln M Tracy
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia; Health Data Research UK, Swansea University Medical School, Swansea University, Singleton Park, Swansea, Wales, United Kingdom.
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15
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Yeong EK, Sheng WH. Does early bloodstream infection pose a significant risk of in-hospital mortality in adults with burns? JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2021; 55:95-101. [PMID: 33563562 DOI: 10.1016/j.jmii.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/18/2021] [Accepted: 01/18/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUD/PURPOSE Bloodstream infections (BSI) are common in patients with major burns, but its effect on mortality remains controversial. This study was aimed to investigate if BSI is significant risk factor of mortality? METHODS This is a retrospective chart review study included 266 adult patients admitted to our burn center from 2000 to 2019. Age, sex, inhalation injuries, total burn surface area (TBSA), duration of stay in intensive care unit, BSI and mortality were variables studied. Fisher exact test, Mann-Whitney test and logistic regression was used for statistical analysis. RESULTS There were 234 survivors and 32 non-survivors. Male was predominant. The overall incidence of BSI was 18.8%, and the overall crude mortality was 12%. Burns ≥30% TBSA and BSI were significant risk factors. A predictive function based on30% TBSA and BSI within 14 days after the onset of burns (BSI-14) was derived. The function has a sensitivity of 0.97, specificity of 0.42 and achieved a maximum Youden Index at functional value ≥0.05727. The mortality probability of BSI-14 in burns ≥30% TBSA was 40.8%. CONCLUSIONS BSI and burns ≥30% TBSA were significant risk factors of mortality. Early detection of BSI-14 is critical in burn care as its probability of mortality can be as high as 40% in patients ≥30% TBSA of burns. To reduce the risk of mortality, early in ventilator withdrawal, invasive lines and tubes removal, and early grafting should be emphasized besides infection control and appropriate use of antibiotics.
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Affiliation(s)
- Eng-Kean Yeong
- Surgical Department Plastic Division Burn Centre, National Taiwan University Hospital, Taipei, Taiwan
| | - Wang-Huei Sheng
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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16
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Liao PH, Kao CC, How CK, Yang YS, Chen MC, Hung-Tsang Yen D, Lee YT. Initial white blood cell count and revised Baux score predict subsequent bloodstream infection in burn patients: A retrospective analysis of severe burn patients from the Formosa color dust explosion of 2015. J Formos Med Assoc 2020; 120:1719-1728. [PMID: 33342706 DOI: 10.1016/j.jfma.2020.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 10/14/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Infections are the most common complications among hospitalized severe burn patients. However, limited literature reports early effective predictors of bloodstream infections (BSI) among burn patients. This study aimed to identify cost-effective biomarkers and valuable clinical scoring systems in the emergency department (ED) for the prediction of subsequent BSI in mass burn casualties. METHODS In 2015, a flammable cornstarch-based powder explosion resulted in 499 burn casualties in Taiwan. A total of 35 patients were admitted at Taipei Veterans General Hospital. These severe burn patients (median total body surface area [TBSA] 54%) were young and previously healthy. We assessed the potential of various parameters to predict subsequent BSI, including initial laboratory tests performed at the ED, TBSA, and multiple scoring systems. RESULTS Fourteen patients (40.0%) had subsequent BSI. The most common causative pathogen was the Acinetobacter baumannii (Ab) group, mostly carbapenem resistant and associated with a poor outcome. The area under the receiver operating characteristic curve revealed that the revised Baux score, TBSA, and initial white blood cell count had excellent discrimination ability in predicting subsequent BSI (0.898, 0.889, and 0.821, respectively). The rate of subsequent BSI differed significantly at the cut-off points of revised Baux score >76, TBSA >55%, and WBC count >16,200/mm3. CONCLUSION The initial WBC count at the ED, TBSA, and revised Baux score were good and cost-effective biomarkers for predicting subsequent BSI after burn injuries.
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Affiliation(s)
- Po-Hsiang Liao
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Chun Kao
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chorng-Kuang How
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ya-Sung Yang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Mei-Chun Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Plastic and Reconstructive Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - David Hung-Tsang Yen
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Tzu Lee
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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17
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Escandón-Vargas K, Tangua AR, Medina P, Zorrilla-Vaca A, Briceño E, Clavijo-Martínez T, Tróchez JP. Healthcare-associated infections in burn patients: Timeline and risk factors. Burns 2020; 46:1775-1786. [DOI: 10.1016/j.burns.2020.04.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 03/13/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023]
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18
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'Poverty's scar: A qualitative inquiry of financing shortcomings in specialized burn hospitals. Burns 2020; 47:1191-1202. [PMID: 33293154 DOI: 10.1016/j.burns.2020.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/12/2020] [Accepted: 10/21/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Victims of burn have particular characteristics such as high vulnerability, expensive treatment, and cost of burn services. Thus, the financing of burn services is crucially important. The purpose of the present work is to recognize the financing challenges in Iranian specialized burn hospitals (SBHs). METHODS In the present qualitative descriptive research, purposive sampling was used for selecting key informants with maximum variation at local, provincial, and national levels. Semi-structured interviews were used for data collection. Interviews were continued as long as the saturation point was achieved at the 21 st interview. We employed conventional content analysis using an inductive data-driven coding process and theme development for the analysis of the transcribed documents by MAXQDA Analytics Pro 2018 (VERBI GmbH Release 18.2.0 Berlin). RESULTS We extracted 3 themes and 12 sub-themes, including resource mobilization (the poor burnt victims, unique feature of the single- SBH, high direct and indirect costs, and poor intra-sectoral advocacy), insurance coverage for burn care (incomplete breadth of population coverage, inadequate depth of benefits package and coverage of costs, and reimbursements of burn care) and mechanism of financial resource allocation (unsuitable payment system, less sustainable budgeting, inappropriate tariffing for burning services, top-down budgeting approach, and politicized budget process). CONCLUSIONS We suggest that health policy-makers in Iran could modify the SBHs financing system by improving resource mobilization, scaling up insurance coverage for burns, and optimizing the allocation of financial resources. Besides, we propose several points for policy entry to address SBHs financial difficulties. These points are serious attention to vulnerable and the poor burn patients, provision of burn care in multi-specialized hospitals, strengthening intra-collaboration, revision of tariffs, and payments for burn services, and preservation and realization of burn budgeting.
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19
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Mohebali A, Abdouss M. Layered biocompatible pH-responsive antibacterial composite film based on HNT/PLGA/chitosan for controlled release of minocycline as burn wound dressing. Int J Biol Macromol 2020; 164:4193-4204. [PMID: 32891643 DOI: 10.1016/j.ijbiomac.2020.09.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 12/20/2022]
Abstract
In the present study, a promising pH-responsive wound dressing was prepared. Halloysite nanotube (HNT) composites were modified with different concentration of both poly (lactic-co-glycolic acid) (PLGA) and chitosan (CS) through the Layer-by-Layer (LbL) strategy for targeted and controlled drug delivery of minocycline (MC). The resulting composites were characterized by FT-IR, XRD, zeta-potential, TGA, FE-SEM and TEM studies. Studying the biodegradability, water uptake, photostability, and water vapor transmission of resulting composites revealed that the composite film absorbed wound secretions, did not degrade, and penetrated properly to wound during the treatment. The results of protein adsorption showed that the optimized composite (C40P60MNT) was blood-compatible. Studying the release profile of the drug showed pH-responsive behavior that was fitted with Korsmeyer-Peppas kinetic model. In-vitro antibacterial testing showed that the C40P60MNT sample had an acceptable effect on the inhibition of gram-positive and gram-negative bacteria. In wound healing test (in-vivo studies), this MC loaded composite film showed faster healing of the burn wound in rat compare to the control sample. Due to the characteristics of the optimized sample, it can be considered as a promising candidate for pH-responsive drug delivery in the treatment of chronic burn wounds.
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Affiliation(s)
- Alireza Mohebali
- Amirkabir University of Technology, Department of Chemistry, No. 350, Hafez Ave, Valiasr Square, Tehran 1591634311, Iran
| | - Majid Abdouss
- Amirkabir University of Technology, Department of Chemistry, No. 350, Hafez Ave, Valiasr Square, Tehran 1591634311, Iran.
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20
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Nisar S, Kirkpatrick LD, Shupp JW. Bacterial Virulence Factors and Their Contribution to Pathophysiology after Thermal Injury. Surg Infect (Larchmt) 2020; 22:69-76. [PMID: 32735479 DOI: 10.1089/sur.2020.188] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Bacterial infections are the leading cause of morbidity and mortality in burn-injured patients. Pseudomonas aeruginosa and Staphylococcus aureus are among the most common pathogens responsible for infections in thermally injured patients. These and other pathogens have developed a variety of virulence factors to colonize and infect hosts. Methods: A comprehensive literature review was conducted to best summarize the current knowledge of how virulence factors contribute to bacterial pathogenicity. Results: The review highlights the unique mechanisms bacteria utilize to evade host defense systems and further complicate the treatment of burn-injured patients. Conclusion: Further research on virulence factors and their contribution to bacterial pathogenicity is warranted and could potentially lead to development of neutralizing pharmacotherapy that would complement antimicrobial treatment.
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Affiliation(s)
- Saira Nisar
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA
| | - Liam D Kirkpatrick
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA
| | - Jeffrey W Shupp
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA.,The Burn Center, MedStar Washington Hospital Center, Washington, DC, USA.,Department of Biochemistry and Molecular and Cellular Biology, Georgetown University School of Medicine, Washington, DC, USA.,Department of Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
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Corcione S, Pensa A, Castiglione A, Lupia T, Bortolaso B, Romeo MR, Stella M, Rosa FGD. Epidemiology, prevalence and risk factors for infections in burn patients: results from a regional burn centre's analysis. J Chemother 2020; 33:62-66. [PMID: 32588768 DOI: 10.1080/1120009x.2020.1780776] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Burn patients are at high risk of infections due to severe impairment of immunity and loss of skin barrier function. We aimed to describe the epidemiology, incidence and risk factors for infection in a cohort of burns patients. Two hundred patients were retrospectively enrolled and subdivided into infected (N = 81) and uninfected groups (N = 119). The cumulative prevalence of infections was 27% on day 7 and 43.8% on day 28. Skin and soft tissue infections (32%) were the most frequent. Carbapenem-resistant Acinetobacter baumannii (28%), Pseudomonas aeruginosa (26%) and methicillin-resistant Staphylococcus aureus (25%) infections were most prevalent. An indwelling central venous catheter (CVC; sub-hazard ratio [SHR] 7.41, 95% confidence interval [CI] 3.78-14.62) and revised Baux score (RBS; SHR 2.08, 95% CI 0.98-4.42) were associated with higher incremental infection rate while surgical treatment resulted in a protective factor (SHR 0.45, 95% CI 0.29-0.75). RBS may be useful to stratify the infection risk: a strict collaboration between surgeons and infectious disease specialists is needed to implement source control and antimicrobial surveillance.
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Affiliation(s)
- Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Anna Pensa
- Burn Center, A.O.U Città della Salute e della Scienza, CTO Hospital, Turin, Italy
| | - Anna Castiglione
- Unit of Clinical Epidemiology, A.O.U Città della Salute e della Scienza, Turin, Italy
| | - Tommaso Lupia
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Barbara Bortolaso
- Laboratory of Clinical Biochemistry, A.O. U Città della Salute e della Scienza, C. T. O Hospital, Turin, Italy
| | - Maria Rosa Romeo
- Burn Center, A.O.U Città della Salute e della Scienza, CTO Hospital, Turin, Italy
| | - Maurizio Stella
- Burn Center, A.O.U Città della Salute e della Scienza, CTO Hospital, Turin, Italy
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Kartchner LB, Gode CJ, Dunn JLM, Glenn LI, Duncan DN, Wolfgang MC, Cairns BA, Maile R. One-hit wonder: Late after burn injury, granulocytes can clear one bacterial infection but cannot control a subsequent infection. Burns 2019; 45:627-640. [PMID: 30833100 DOI: 10.1016/j.burns.2018.08.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 07/04/2018] [Accepted: 08/07/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Burn injury induces an acute hyperactive immune response followed by a chronic immune dysregulation that leaves those afflicted susceptible to multiple secondary infections. Many murine models are able to recapitulate the acute immune response to burn injury, yet few models are able to recapitulate long-term immune suppression and thus chronic susceptibility to bacterial infections seen in burn patients. This has hindered the field, making evaluation of the mechanisms responsible for these susceptibilities difficult to study. Herein we describe a novel mouse model of burn injury that promotes chronic immune suppression allowing for susceptibility to primary and secondary infections and thus allows for the evaluation of associated mechanisms. METHODS C57Bl/6 mice receiving a full-thickness contact burn were infected with Pseudomonas aeruginosa 14 days (primary infection) and/or 17 days (secondary infection) after burn or sham injury. The survival, pulmonary and systemic bacterial load as well as frequency and function of innate immune cells (neutrophils and macrophages) were evaluated. RESULTS Following secondary infection, burn mice were less effective in clearance of bacteria compared to sham injured or burn mice following a primary infection. Following secondary infection both neutrophils and macrophages recruited to the airways exhibited reduced production of anti-bacterial reactive oxygen and nitrogen species and the pro-inflammatory cytokineIL-12 while macrophages demonstrated increased expression of the anti-inflammatory cytokine interleukin-10 compared to those from sham burned mice and/or burn mice receiving a primary infection. In addition the BALF from these mice contained significantly higher level so of the anti-inflammatory cytokine IL-4 compared to those from sham burned mice and/or burn mice receiving a primary infection. CONCLUSIONS Burn-mediated protection from infection is transient, with a secondary infection inducing immune protection to collapse. Repeated infection leads to increased neutrophil and macrophage numbers in the lungs late after burn injury, with diminished innate immune cell function and an increased anti-inflammatory cytokine environment.
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Affiliation(s)
- Laurel B Kartchner
- Department of Microbiology and Immunology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Cindy J Gode
- Department of Microbiology and Immunology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Marsico Lung Institute/Cystic Fibrosis Research Center, USA
| | - Julia L M Dunn
- Department of Microbiology and Immunology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lindsey I Glenn
- Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Danté N Duncan
- Department of Microbiology and Immunology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Matthew C Wolfgang
- Department of Microbiology and Immunology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Marsico Lung Institute/Cystic Fibrosis Research Center, USA
| | - Bruce A Cairns
- Department of Microbiology and Immunology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Jaycee Burn Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Robert Maile
- Department of Microbiology and Immunology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Department of Surgery, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA; Jaycee Burn Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
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Guo HL, Zhao GJ, Ling XW, Xu JJ, Lu CJ, Liu ZJ. Using competing risk and multistate model to estimate the impact of nosocomial infection on length of stay and mortality in burn patients in Southeast China. BMJ Open 2019; 8:e020527. [PMID: 30798283 PMCID: PMC6278804 DOI: 10.1136/bmjopen-2017-020527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 09/16/2018] [Accepted: 09/20/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Due to the defects in skin barrier function and immune response, burn patients who survive the acute phase of a burn injury are at a high risk of nosocomial infection (NI). The aim of this study is to evaluate the impacts of NI on length of stay (LOS) and hospital mortality in burn patients using a multistate model. DESIGN AND SETTING A retrospective observational study was conducted in burn unit and intensive care unit in the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China. PARTICIPANTS Data were obtained from 1143 records of patients admitted with burn between 1 January 2013 and 31 December 2016. METHODS Risk factors for NIs were determined by binary logistic regression. The extended Cox model with time-varying covariates was used to determine the impact of NIs on hospital mortality, and cumulative incidence functions were calculated. Multiple linear regression analysis was applied to detect the variables associated with LOS. Using a multistate model, the extra LOS due to NI were determined. RESULTS 15.8% of total burn patients suffered from NIs and incidence density of NIs was 9.6 per 1000 patient-days. NIs significantly increased the rate of death (HR 4.266, 95% CI 2.218 to 8.208, p=0.000). The cumulative probability of death for patients with NI was greater that for those without NI. The extra LOS due to NIs was 17.68 days (95% CI 11.31 to 24.05). CONCLUSIONS Using appropriate statistical methods, the present study further illustrated that NIs were associated with the increased cumulative incidence of burn death and increased LOS in burn patients.
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Affiliation(s)
- Hai-Lei Guo
- Department of Burns Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guang-Ju Zhao
- Emergency Department, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiang-Wei Ling
- Department of Burns Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jian-Jun Xu
- Department of Burns Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Cai-Jiao Lu
- Department of Burns Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zheng-Jun Liu
- Department of Burns Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Aurora A, Le TD, Akers KS, Blyth DM, Graybill JC, Clemens MS, Chung KK, Rizzo JA. Recurrent bacteremia: A 10-year retrospective study in combat-related burn casualties. Burns 2018; 45:579-588. [PMID: 30385059 DOI: 10.1016/j.burns.2018.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 08/27/2018] [Accepted: 10/04/2018] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Surviving the first episode of bacteremia predisposes burn casualties to its recurrence. Herein, we investigate the incidence, mortality, bacteriology, and source of infection of recurrent bacteremia in military burn casualties admitted to the U.S. Army Institute of Surgical Research Burn Center over a 10year period. METHODS Bacteremia was defined as the growth of Gram-positive or Gram-negative organisms in a blood culture that excluded probable skin contaminants. Recurrent bacteremia was defined as a subsequent episode of bacteremia ≥7 days after the first episode. Polymicrobial bacteremia was the presence of more than one pathogen in the same blood culture. Bacteremia was attributed to UTI, pneumonia, or wound sepsis. All other bacteremias were considered non-attributable bloodstream infections. Univariate and multivariate analyses determined factors predictive of clinical outcome. RESULTS Out of 952 combat-related burn casualties screened, 166 cases were identified; 63% (non-recurrent) and 37% (recurrent) with median time to recurrence of 20 days. Univariate and multivariate analysis showed that the mortality rate was two and nine-fold, respectively, higher with recurrent bacteremia. Univariate analysis found that except for urinary tract infection, large burn size (>20%), 3rd degree burns, increased injuiry severity, perineal burns, and mechanical ventilator days were independent factors predictive of recurrence of bacteremia as well as increased mortality in the recurrent bacteremia cohort. Acinetobacter baumannii complex (63%) was prevalent in the non-recurrent group, while Klebsiella pneumoniae (46% vs. 30%) and Pseudomonas aeruginosa (35% vs. 26%) were prevalent in recurrent bacteremia. Half of the recurrent bacteremia cases were polymicrobial, compared to 9% in non-recurrent bacteremia. Pneumonia was prevalent in non-recurrent bacteremia (38%) and a combination of pneumonia and wound sepsis (29%) in recurrent bacteremia casualties. CONCLUSIONS Recurrent bacteremia increases mortality in military burn casualties. Additional research is needed to address and mitigate the underlying causes, thereby improving survival.
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Affiliation(s)
- Amit Aurora
- U.S. Army Institute of Surgical Research, JBSA, Fort Sam Houston, TX, United States
| | - Tuan D Le
- U.S. Army Institute of Surgical Research, JBSA, Fort Sam Houston, TX, United States
| | - Kevin S Akers
- U.S. Army Institute of Surgical Research, JBSA, Fort Sam Houston, TX, United States; Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Dana M Blyth
- Brooke Army Medical Center, JBSA, Fort Sam Houston, TX, United States
| | - John C Graybill
- U.S. Army Institute of Surgical Research, JBSA, Fort Sam Houston, TX, United States
| | - Michael S Clemens
- U.S. Army Institute of Surgical Research, JBSA, Fort Sam Houston, TX, United States
| | - Kevin K Chung
- U.S. Army Institute of Surgical Research, JBSA, Fort Sam Houston, TX, United States; Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Julie A Rizzo
- U.S. Army Institute of Surgical Research, JBSA, Fort Sam Houston, TX, United States; Uniformed Services University of the Health Sciences, Bethesda, MD, United States.
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Chen P, Stanojcic M, Jeschke MG. Septic predictor index: A novel platform to identify thermally injured patients susceptible to sepsis. Surgery 2017; 163:409-414. [PMID: 29129362 DOI: 10.1016/j.surg.2017.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 08/17/2017] [Accepted: 08/30/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND During the past decades' sepsis has become the major cause of death in severely burned patients. Despite the importance of burn sepsis, its diagnosis, let alone its prediction, is difficult if not impossible. Recently, we have demonstrated burn patients have increased NLRP3 inflammasome activation in white adipose tissue. We aimed to delineate a unique immune profile that can be used to identify septic outcomes in severely burned patients. METHODS Adult burn patients (n = 37) admitted to our burn center between June 2013-2015 were enrolled in this study. White adipose tissue from the site of injury and plasma were collected from severely burned patients (>20% total body surface area) within 96 hours after thermal injury, indiscriminate of sex or age. RESULTS We found that patients exhibiting aberrantly high levels of proinflammatory interleukin-1β and decreased macrophages at the site of injury are highly susceptible to development of sepsis. Septic patients also had increased anti-inflammatory (interleukin-10, interleukin-1RA) cytokines in plasma. The Septic Predictor Index was generated as a quotient for the site of injury macrophage proportion and interleukin-1β production. All patients who eventually develop sepsis had septic predictor index values >0.5. Septic patients with Septic Predictor Index values >1 all had sepsis onset within 12 days post-injury, whereas patients with Septic Predictor Index values between 0.5-1 all had later onset (>12 days). CONCLUSION The Septic Predictor Index can determine sepsis onset accurately in thermally injured patients a priori and further enables surgeons to develop clinical studies and focused therapies specifically designed for septic cohorts.
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Affiliation(s)
- Peter Chen
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | | | - Marc G Jeschke
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Division of Plastic Surgery Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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Utility of Sequential Organ Failure Assessment score in predicting bacteremia in critically ill burn patients. Am J Surg 2017; 215:478-481. [PMID: 29089098 DOI: 10.1016/j.amjsurg.2017.09.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/22/2017] [Accepted: 09/26/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND We evaluated whether qSOFA ≥2 and an increase in SOFA (ΔSOFA) ≥2 can help predict bacteremia in a critically ill burn population. METHODS Patients age ≥15 and TBSA ≥15% admitted between 2009 and 2015 were included. All blood cultures were recorded, and positive and negative blood culture days were defined based on the culture results. SOFA and qSOFA scores were compared between positive and negative blood culture days. RESULTS There were 50 patients in our study with a mean age of 47yrs and mean TBSA burn of 37%. Bacteremic patients had larger TBSA and full thickness burns, higher revised Baux score, and longer hospital LOS, without a difference in mortality, compared to non-bacteremic patients. There was no difference in qSOFA and SOFA scores between positive and negative blood culture days. A ΔSOFA ≥5 was highly specific for positive blood culture days. CONCLUSIONS SOFA and qSOFA have limited ability to predict bacteremia in critically ill burn patients.
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Use of Implementation Science for a Sustained Reduction of Central-Line-Associated Bloodstream Infections in a High-Volume, Regional Burn Unit. Infect Control Hosp Epidemiol 2017; 38:1306-1311. [PMID: 28899444 DOI: 10.1017/ice.2017.191] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We describe the use of implementation science at the unit level and organizational level to guide an intervention to reduce central-line-associated bloodstream infections (CLABSIs) in a high-volume, regional, burn intensive care unit (BICU). DESIGN A single center observational quasi-experimental study. SETTING A regional BICU in Maryland serving 300-400 burn patients annually. INTERVENTIONS In 2011, an organizational-level and unit-level intervention was implemented to reduce the rates of CLABSI in a high-risk patient population in the BICU. At the organization level, leaders declared a goal of zero infections, created an infrastructure to support improvement efforts by creating a coordinating team, and engaged bedside staff. Performance data were transparently shared. At the unit level, the Comprehensive Unit-based Safety Program (CUSP)/ Translating Research Into Practice (TRIP) model was used. A series of interventions were implemented: development of new blood culture procurement criteria, implementation of chlorhexidine bathing and chlorhexidine dressings, use of alcohol impregnated caps, routine performance of root-cause analysis with executive engagement, and routine central venous catheter changes. RESULTS The use of an implementation science framework to guide multiple interventions resulted in the reduction of CLABSI rates from 15.5 per 1,000 central-line days to zero with a sustained rate of zero CLABSIs over 3 years (rate difference, 15.5; 95% confidence interval, 8.54-22.48). CONCLUSIONS CLABSIs in high-risk units may be preventable with the a use a structured organizational and unit-level paradigm. Infect Control Hosp Epidemiol 2017;38:1306-1311.
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Lin TC, Wu RX, Chiu CC, Yang YS, Lee Y, Lin JC, Chang FY. The clinical and microbiological characteristics of infections in burn patients from the Formosa Fun Coast Dust Explosion. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 51:267-277. [PMID: 28705768 DOI: 10.1016/j.jmii.2016.08.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/29/2016] [Accepted: 08/30/2016] [Indexed: 10/19/2022]
Abstract
BACKGROUND/PURPOSE Bloodstream infection is a leading cause of mortality among burn patients. This study aimed to evaluate the risk factors, causative pathogens, and the relationship between bloodstream infections and other infections among burn patients from the Formosa Fun Coast Dust Explosion. METHODS This retrospective study evaluated the demographic and clinical characteristics, infection types, causative pathogen(s), and isolates' antibiotic susceptibilities from patients who were hospitalized between June 27 and September 31, 2015. RESULTS Fifty-eight patients were admitted during the study period (36 males, mean age: 22.6 years). The mean burned total body surface area (TBSA) was 40% for all patients. Eighteen (31%) patients with mean TBSA of 80% had 66 episodes of bloodstream infections caused by 92 isolates. Twelve (18.2%) episodes of bloodstream infections were polymicrobial. Acinetobacter baumannii (19, 20.7%), Ralstonia pickettii (17, 18.5%), and Chryseobacterium meningosepticum (13, 14.1%) were the most common pathogens causing bloodstream infections. A high concordance rate of wound cultures with blood cultures was seen in Staphylococcus aureus (3, 75%) and C. meningosepticum (8, 61.5%) infections. However, no Ralstonia isolate was found in burn wounds of patients with Ralstonia bacteremia. A high concordance rate of central venous catheter cultures with blood cultures was noted in Ralstonia mannitolilytica (5, 62.5%) and Chryseobacterium indologenes (3, 60%) infections. Approximately 21.1% of A. baumannii strains were resistant to carbapenem. All S. aureus isolates were susceptible to methicillin. CONCLUSIONS Waterborne bacteria should be considered in patients of burns with possible water contact. Empirical broad-spectrum antibiotics should be considered for patients who were hospitalized for severe sepsis, or septic shock with a large burn. Antibiotic treatment should be administered based on the specific pathogens and their detection points.
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Affiliation(s)
- Tzu-Chao Lin
- Department of Internal Medicine, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan; Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Rui-Xin Wu
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Chien Chiu
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Ya-Sung Yang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi Lee
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Jung-Chung Lin
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Feng-Yee Chang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Tang CQ, Li JQ, Shou BM, Pan BH, Chen TS, Xiao YQ, Zheng XP, Xiao SC, Tan Q, Xia ZF. Epidemiology and outcomes of bloodstream infections in 177 severe burn patients from an industrial disaster: a multicentre retrospective study. Clin Microbiol Infect 2017. [PMID: 28642142 DOI: 10.1016/j.cmi.2017.06.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To determine the characteristics of bloodstream infections (BSIs) and to evaluate the impact of BSIs on mortality in severe burn patients. METHODS A retrospective observational study was conducted in 20 tertiary hospitals. A total of 185 patients who experienced a massive dust explosion in eastern China were included. RESULTS After exclusion, 177 patients were analysed. The median total body surface area (TBSA) burned was 95% (interquartile range 85%-98%). Inhalation injuries occurred in 97.2%. The overall 90-day mortality was 35% (62/177). During the study period, 120 (67.8%) patients developed 253 episodes of BSI with 323 unique causative pathogens. Sixty-six episodes were polymicrobial infections. Catheter-related BSIs (CRBSIs) accounted for 41.5% of the episodes. Acinetobacter baumannii (19.5%), Klebsiella pneumoniae (13.9%) and Candida (12.7%) were the most common organisms. Antimicrobial resistance was found in 63.5% of the isolates, particularly in Gram-negative bacteria. Patients who developed BSIs had a greater illness severity at admission to the intensive care unit, and worse outcomes. After adjusting for demographics, severity of illness and treatment characteristics in a multivariate logistic model, there was a trend toward BSI increasing the risk of 90-day mortality (adjusted OR 3.4; 95% CI 0.9-12.9; p=0.069). In subgroup analyses, CRBSIs (adjusted OR 5.7; 95% CI 1.3-24.9; p=0.021 versus no BSI) and polymicrobial BSIs (adjusted OR 6.1; 95% CI 1.3-28.1; p=0.020 versus no BSI) had greater risk of 90-day mortality. CONCLUSIONS A strikingly high rate of BSIs was observed in severe burn patients. Gram-negative organisms and fungi were the leading causes. CRBSIs and polymicrobial BSIs were associated with high mortality.
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Affiliation(s)
- C Q Tang
- Department of Burn Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - J Q Li
- Department of Burn Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - B M Shou
- Department of Burns and Plastic Surgery, The Drum Tower Clinical Medical College, Nanjing Medical University, Nanjing, Jiangsu, China
| | - B H Pan
- Department of Burn Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - T S Chen
- Department of Burn Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Y Q Xiao
- Department of Burn Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - X P Zheng
- Department of Burn Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - S C Xiao
- Department of Burn Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China.
| | - Q Tan
- Department of Burns and Plastic Surgery, Affiliated Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China.
| | - Z F Xia
- Department of Burn Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China.
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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Explain the epidemiology of severe burn injury in the context of socioeconomic status, gender, age, and burn cause. 2. Describe challenges with burn depth evaluation and novel methods of adjunctive assessment. 3. Summarize the survival and functional outcomes of severe burn injury. 4. State strategies of fluid resuscitation, endpoints to guide fluid titration, and sequelae of overresuscitation. 5. Recognize preventative measures of sepsis. 6. Explain intraoperative strategies to improve patient outcomes, including hemostasis, restrictive transfusion, temperature regulation, skin substitutes, and Meek skin grafting. 7. Translate updates in the pathophysiology of hypertrophic scarring into novel methods of clinical management. 8. Discuss the potential role of free tissue transfer in primary and secondary burn reconstruction. SUMMARY Management of burn-injured patients is a challenging and unique field for plastic surgeons. Significant advances over the past decade have occurred in resuscitation, burn wound management, sepsis, and reconstruction that have improved outcomes and quality of life after thermal injury. However, as patients with larger burns are resuscitated, an increased risk of nosocomial infections, sepsis, compartment syndromes, and venous thromboembolic phenomena have required adjustments in care to maintain quality of life after injury. This article outlines a number of recent developments in burn care that illustrate the evolution of the field to assist plastic surgeons involved in burn care.
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Sakabe D, Del Fiol FDS. Profile of infections and antimicrobial treatment among burn-injury patients. Am J Infect Control 2016; 44:950-2. [PMID: 27324611 DOI: 10.1016/j.ajic.2016.03.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/02/2016] [Accepted: 03/03/2016] [Indexed: 10/21/2022]
Abstract
Infections are the leading cause of morbidity and mortality among burn-injury patients. Even in the absence of documented infection, antibiotics are often given to burn-injury patients at the beginning of treatment, an empirical measure in response to signs and symptoms of infection. The choice of antimicrobial therapy for these patients should be based on technical criteria, based on laboratory findings, at the risk of further increasing antimicrobial resistance levels.
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Hidalgo F, Mas D, Rubio M, Garcia-Hierro P. Infections in critically ill burn patients. Med Intensiva 2016; 40:179-85. [PMID: 27013315 DOI: 10.1016/j.medin.2016.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 02/18/2016] [Indexed: 10/22/2022]
Abstract
Severe burn patients are one subset of critically patients in which the burn injury increases the risk of infection, systemic inflammatory response and sepsis. The infections are usually related to devices and to the burn wound. Most infections, as in other critically ill patients, are preceded by colonization of the digestive tract and the preventative measures include selective digestive decontamination and hygienic measures. Early excision of deep burn wound and appropriate use of topical antimicrobials and dressings are considered of paramount importance in the treatment of burns. Severe burn patients usually have some level of systemic inflammation. The difficulty to differentiate inflammation from sepsis is relevant since therapy differs between patients with and those without sepsis. The delay in prescribing antimicrobials increases morbidity and mortality. Moreover, the widespread use of antibiotics for all such patients is likely to increase antibiotic resistance, and costs. Unfortunately the clinical usefulness of biomarkers for differential diagnosis between inflammation and sepsis has not been yet properly evaluated. Severe burn injury induces physiological response that significantly alters drug pharmacokinetics and pharmacodynamics. These alterations impact antimicrobials distribution and excretion. Nevertheless the current available literature shows that there is a paucity of information to support routine dose recommendations.
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Affiliation(s)
- F Hidalgo
- Department of Critical Care Medicine, Hospital Universitario de Getafe, Madrid, Spain.
| | - D Mas
- Department of Plastic Surgery, Hospital Universitario de Getafe, Madrid, Spain
| | - M Rubio
- Department of Critical Care Medicine, Hospital Universitario de Getafe, Madrid, Spain
| | - P Garcia-Hierro
- Department of Microbiology, Hospital Universitario de Getafe, Madrid, Spain
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In situ diagnostic methods for catheter related bloodstream infection in burns patients: A pilot study. Burns 2016; 42:434-40. [PMID: 26778703 DOI: 10.1016/j.burns.2015.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 06/20/2015] [Accepted: 07/09/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND One of the most common and potentially fatal complications in critically ill burns patients is catheter related bloodstream infection (CR-BSI). Lack of in situ diagnostic techniques requires device removal if CR-BSI is suspected with 75-85% of catheters withdrawn unnecessarily. AIMS To assess the sensitivity, specificity and accuracy of two in situ diagnostic methods for CR-BSI in an adult ICU burns population: Differential Time to Positivity (DTP) and Semi-Quantitative Superficial Cultures (SQSC). METHODS Both arterial (AC) and central venous (CVC) catheters were studied. On clinicians' suspicion of CR-BSI, the CVC and AC were removed. Superficial semi-quantitative cultures were taken by removing the dressings and swabbing within a 3cm radius of the CVC and AC insertion sites, as well as inside each hub of the CVC and AC. Peripheral blood was taken for qualitative culture and the catheter tip sent for semi-quantitative culture. DTP was considered positive if culture of lumen blood became positive at least 120min before peripheral blood with an identical pathogen. Superficial and tip cultures were identified as positive if ≥15 CFUs were grown. CR-BSI was confirmed when both catheter tip culture and peripheral blood culture were positive with the same micro-organism. RESULTS Sixteen patients (88% male) with an APACHE II score of 22.0 (7.3) were enrolled. The mean age was 45.7 (16.9) years with mean total burn surface area 32.9 (19.4)%. Fifty percent had airway burns. ICU stay was 19.9 (11.1) days. All 16 survived ICU discharge with a hospital survival of 93%. There were 20 episodes of CR-BSI in these 16 patients. For these 20 episodes the exposure time (line days) was 113.15. The CR-BSI rate was 15.6 per 1000 catheter days (95% CI 1.9-56.4). For diagnosis of CR-BSI in either AC and CVC, SQSC had a sensitivity of 50% [95% CI 3-97], specificity 83.3% [95% CI 67-93], PPV 14.3 [95% CI 1-58], NPV 96.8 [95% CI 81-100], accuracy of 81.6% [95%CI 65-92] and diagnostic odds ratio 5.0 [95% CI 0.3-91.5]. To diagnose tip colonisation (>15CFU), sensitivity of SQSC was 75% [95% CI 22-99], specificity 88.2% [95%CI 72-96], PPV 42.7 [95% CI 12-80], NPV96.8% [95% CI 81-100], accuracy 86.8% [95% CI 71-95] and diagnostic odds ratio 22.5 [95% CI 1.9-271.9]. For combined DTP blood cultures, sensitivity for CR-BSI was 50% [95% CI 3-97], with specificity 97% [95% CI 82-100], PPV 50% [5% CI 3-97%], NPV 97% [95% CI 82-100], accuracy 94.3% 95% CI 79-99] and diagnostic odds ratio 32 [95% CI 1.1-970.8]. CONCLUSION Both DTP and SQSC displayed high specificity, NPV and accuracy in a population of adult burns patients. These features may make these tests useful for ruling out CR-BSI in this patient group. This study was limited by a low number of events and further research is required.
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Wang KA, Sun Y, Wu GS, Wang YR, Xia ZF. Epidemiology and outcome analysis of hand burns: A 5-year retrospective review of 378 cases in a burn center in Eastern China. Burns 2015; 41:1550-5. [DOI: 10.1016/j.burns.2015.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 04/18/2015] [Accepted: 04/20/2015] [Indexed: 10/23/2022]
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Lundy JB, Chung KK, Pamplin JC, Ainsworth CR, Jeng JC, Friedman BC. Update on Severe Burn Management for the Intensivist. J Intensive Care Med 2015; 31:499-510. [PMID: 26112758 DOI: 10.1177/0885066615592346] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 06/01/2015] [Indexed: 11/15/2022]
Abstract
Thermal injury of humans causes arguably the most severe perturbations in physiology that can be experienced. These physiologic derangements start immediately and can persist in some form until months or even years after the burn wounds are healed. Burn shock, marked activation of the systemic inflammatory response, multiple-organ failure, infection, and wound failure are just a few of the insults that may require management by the intensivist. The purpose of this article is to review recent advances in the critical care management of thermally injured patients.
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Affiliation(s)
- Jonathan B Lundy
- Burn Center, United States Army Institute of Surgical Research, Fort Sam Houston, TX, USA Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Kevin K Chung
- Burn Center, United States Army Institute of Surgical Research, Fort Sam Houston, TX, USA Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jeremy C Pamplin
- Burn Center, United States Army Institute of Surgical Research, Fort Sam Houston, TX, USA Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Craig R Ainsworth
- Department of Medicine, William Beaumont Army Medical Center, Fort Bliss, TX, USA
| | - James C Jeng
- Department of Surgery, Mount Sinai Beth Israel Medical Center, New York, NY, USA
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Rowan MP, Cancio LC, Elster EA, Burmeister DM, Rose LF, Natesan S, Chan RK, Christy RJ, Chung KK. Burn wound healing and treatment: review and advancements. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:243. [PMID: 26067660 PMCID: PMC4464872 DOI: 10.1186/s13054-015-0961-2] [Citation(s) in RCA: 465] [Impact Index Per Article: 51.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Burns are a prevalent and burdensome critical care problem. The priorities of specialized facilities focus on stabilizing the patient, preventing infection, and optimizing functional recovery. Research on burns has generated sustained interest over the past few decades, and several important advancements have resulted in more effective patient stabilization and decreased mortality, especially among young patients and those with burns of intermediate extent. However, for the intensivist, challenges often exist that complicate patient support and stabilization. Furthermore, burn wounds are complex and can present unique difficulties that require late intervention or life-long rehabilitation. In addition to improvements in patient stabilization and care, research in burn wound care has yielded advancements that will continue to improve functional recovery. This article reviews recent advancements in the care of burn patients with a focus on the pathophysiology and treatment of burn wounds.
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Affiliation(s)
- Matthew P Rowan
- United States Army Institute for Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX, 78234, USA.
| | - Leopoldo C Cancio
- United States Army Institute for Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX, 78234, USA
| | - Eric A Elster
- Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
| | - David M Burmeister
- United States Army Institute for Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX, 78234, USA
| | - Lloyd F Rose
- United States Army Institute for Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX, 78234, USA
| | - Shanmugasundaram Natesan
- United States Army Institute for Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX, 78234, USA
| | - Rodney K Chan
- United States Army Institute for Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX, 78234, USA.,Brooke Army Medical Center, 3551 Roger Brook Dr, Fort Sam Houston, TX, 78234, USA
| | - Robert J Christy
- United States Army Institute for Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX, 78234, USA
| | - Kevin K Chung
- United States Army Institute for Surgical Research, 3698 Chambers Pass, Fort Sam Houston, TX, 78234, USA.,Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
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Savoia D. New perspectives in the management of Pseudomonas aeruginosa infections. Future Microbiol 2014; 9:917-28. [DOI: 10.2217/fmb.14.42] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
ABSTRACT: Infections with Pseudomonas aeruginosa are a major health problem, especially for immune-compromised and cystic fibrosis patients, owing to the particular drug resistance of the microorganism. The aim of this review is to provide recent insights into strategies under investigation for prevention and therapy of these infections. In this survey, the approach directed against bacterial biofilm formation and quorum-sensing systems was focused, along with the evaluation of the treatment with bacteriophages. New interesting, developmental studies and clinical trials to prevent or treat infections due to this opportunistic pathogen are based on active and passive immunotherapy. Some monoclonal antibodies and different vaccines against this microorganism have been developed in the last few decades, even though to date none of them have obtained market authorization.
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Novel application of a spatial frequency domain imaging system to determine signature spectral differences between infected and noninfected burn wounds. J Burn Care Res 2013; 34:44-50. [PMID: 23292572 DOI: 10.1097/bcr.0b013e318269be30] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Complications of infection can increase burn-related morbidity and mortality. Early detection of burn wound infection could lead to more precise and effective treatment, reducing systemic complications and the need for long-term, broad-spectrum intravenous antibiotics. Quantitative cultures from biopsies are the accepted standard to determine infection. However, this methodology can take days to yield results and is invasive. This investigation focuses on the use of noninvasive imaging to determine the infection status of burn wounds in a controlled in vivo model. Full-thickness burn wounds were created on the dorsum of adult male rats (n = 6). Twenty-four hours after burn wound creation, wounds in the "Infected" group were inoculated with a vehicle containing 1 × 10(8) colony forming unit Staphylococcus aureus. "Control" group animals received vehicle alone. Subsequently, the wounds were imaged daily for a total of 10 days and the differences of skin optical properties were assessed using spatial frequency domain imaging at 16 different wavelengths from 500 to 700 nm. Regions of interest on the resulting images were selected and averaged at each time point. Statistically significant differences in average absorption and reduced scattering coefficients (μ(a) and μ(s)') at 620 and 700 nm were observed between the two groups (P < .05). Differential optical properties were most evident by day 4 and persisted throughout the time course. Differential signature changes in optical properties are evident in infected burn wounds. This novel application of spatial frequency domain imaging may prove to be a valuable adjunct to burn wound assessment. Further work will be aimed at determining dose-response relationships and prokaryotic species differences.
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Worgall S. 40 years on: have we finally got a vaccine for Pseudomonas aeruginosa? Future Microbiol 2013; 7:1333-5. [PMID: 23231481 DOI: 10.2217/fmb.12.106] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Abstract
Like the previous year, 2010 was another active year for research in burn care. For this year, more than 1200 burn-related articles were published on a diverse array of topics. In this review, we focus on innovative and impactful burn injury-related research. As in the previous review, we group articles according to the following categories: critical care, infection, inhalation injury, epidemiology, psychology, wound characterization and treatment, nutrition and metabolism, pain and itch management, burn reconstruction, and rehabilitation. We have found that burn research continues to be prolific throughout the world and reflects the wide-ranging and complex care requirements of burn survivors.
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Patel BM, Paratz JD, Mallet A, Lipman J, Rudd M, Muller MJ, Paterson DL, Roberts JA. Characteristics of bloodstream infections in burn patients: An 11-year retrospective study. Burns 2012; 38:685-90. [DOI: 10.1016/j.burns.2011.12.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 11/24/2011] [Accepted: 12/21/2011] [Indexed: 11/30/2022]
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When a hero becomes a patient: firefighter burn injuries in the National Burn Repository. J Burn Care Res 2012; 33:147-51. [PMID: 22138811 DOI: 10.1097/bcr.0b013e31823dea3c] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Firefighters receive significant training and are outfitted with state-of-the-art protective equipment. However, given the unpredictable nature of their work environment, injuries still occur. The National Burn Repository (NBR) was viewed as a resource for defining the epidemiology of these injuries on a national level and to identify predictive factors for outcomes in this population. The NBR was queried for the occupation of "firefighter" for the years 1990-2008. Records were screened for completeness, and 597 patients were identified for analysis. Data examined included demographics, %TBSA burn, length of stay (LOS), injury circumstance, and disposition. Multiple linear regression models were created to determine factors related to outcome measures. The majority of patients were white (84%) and male (96%). The mean age was 35 years. Most injuries were caused by fire/flame (73%). Only six deaths (1%) were reported. Most injuries were work-related (86%), and most patients were discharged home (92%). Inhalation injury was documented in 9% of patients. The mean LOS was 6.5 ± 11.3 days (median 2 days), and few patients had critical care requirements. The average %TBSA was 6 ± 11.7%. Patients with larger injuries had increased LOS. The presence of inhalation injury, elevated carboxyhemoglobin levels, and advancing age were significantly associated with larger burns. From the NBR data, most firefighter burn injuries were small, and few firefighter burn patients required critical care resources or had significant disability. Firefighters comprise a small number of burn center admissions each year, yet they are an important population to consider for burn prevention efforts.
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Comparing a Single Institution’s Experience With Electrical Injuries to the Data Recorded in the National Burn Repository. J Burn Care Res 2012; 33:606-11. [DOI: 10.1097/bcr.0b013e318241b13d] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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